Multi-point fit for patient specific guide

ABSTRACT

A bone preparation system including a guide body and a plurality of bone locators. The guide body is configured to mate with a patient-specific module having a patient-specific module surface customized based on image data of a specific patient to correspond to the patient&#39;s specific bone geometry. The plurality of bone locators are coupled to the guide body and positioned by the patient-specific module surface to define a patient-specific bone engaging surface of the guide corresponding to the patient&#39;s specific bone geometry.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of U.S. Provisional Application No.61/777,555 filed on Mar. 12, 2013. The entire disclosure of the aboveapplication is incorporated herein by reference.

FIELD

The present disclosure relates to a patient-specific bone preparationguide with a multi-point fit.

BACKGROUND

This section provides background information related to the presentdisclosure, which is not necessarily prior art.

Patient-specific bone preparation guides often use MRI, CT, x-ray,ultra-sound, or other image data to create a three-dimensional model ofa patient's bone. From the model, a pre-operative plan can be made andmodified by a surgeon. The pre-operative plan includes a series ofpoints, axes, and planes defined by specific-patient geometry. After thesurgeon approves the pre-operative plan, the patient-specific guide ismade based on the plan to fit the patient's bone. Because the guide isspecific to the anatomy of only one patient, it is typically discardedafter surgery. To conserve costs and materials, a bone preparation guidethat can be customized for multiple patients, and thus be reused formultiple surgeries, would be desirable.

SUMMARY

This section provides a general summary of the disclosure, and is not acomprehensive disclosure of its full scope or all of its features.

The present teachings provide for a bone preparation system including aguide body and a plurality of bone locators. The guide body isconfigured to mate with a patient-specific module having apatient-specific module surface customized based on image data of aspecific patient to correspond to the patient's own specific bonegeometry. The plurality of bone locators are coupled to the guide bodyand positioned by the patient-specific module surface to define apatient-specific bone engaging surface of the guide corresponding to thepatient's own specific bone geometry.

The present teachings further provide for a system for preparing aspecific patient's bone with a bone preparation guide. The systemincludes a guide body and a patient-specific insert. The guide bodyincludes a plurality of bone locators movable into and out of the guidebody. The patient-specific insert is configured to be received by theguide body, and includes a patient-specific insert surface customizedbased on image data of a specific patient to correspond to the patient'sown specific bone geometry. Cooperation between the patient-specificinsert and the guide body positions the bone locators to define apatient-specific bone engaging surface at distal tips of the pluralityof bone locators. The patient-specific bone engaging surface correspondsto the patient's own specific bone geometry.

The present teachings also provide for a method of customizing a bonepreparation guide to correspond to a specific bone geometry of each oneof a plurality of different patients. The method includes: analyzing afirst patient's own specific bone geometry; developing a firstpre-operative plan based on the first patient's own specific bonegeometry, a first patient-specific surface of a first patient-specificguide insert is designed based on the first pre-operative plan; couplingthe first patient-specific guide insert to a guide body, the guide bodyincluding a plurality of bone locators connected thereto that areconfigured to be positioned by the first patient-specific surface of theguide insert to define a first patient-specific bone engaging surface ofthe guide corresponding to the first patient's own specific bonegeometry; positioning the guide body against the first patient's bone ata predetermined location corresponding to the first patient-specificbone engaging surface defined by the plurality of bone locators aspositioned by the first guide insert; and guiding at least one of afirst cutting instrument or a first guide to the first patient's boneusing the guide.

Further areas of applicability will become apparent from the descriptionprovided herein. The description and specific examples in this summaryare intended for purposes of illustration only and are not intended tolimit the scope of the present disclosure.

DRAWINGS

The drawings described herein are for illustrative purposes only ofselected embodiments and not all possible implementations, and are notintended to limit the scope of the present disclosure.

FIG. 1 is a perspective view of a bone preparation guide according tothe present teachings;

FIG. 2 is a perspective view of a patient-specific insert according tothe present teachings for the bone preparation guide;

FIG. 3 is a perspective view of another bone preparation guide andanother patient-specific insert according to the present teachingscoupled thereto;

FIG. 4 illustrates the bone preparation guide of FIG. 1 with thepatient-specific insert coupled thereto positioned at a distal end of afemur; and

FIG. 5 illustrates the bone preparation guide of FIG. 1 with thepatient-specific insert of FIG. 2 coupled thereto, the bone preparationguide seated on the distal end of the femur.

Corresponding reference numerals indicate corresponding parts throughoutthe several views of the drawings.

DETAILED DESCRIPTION

Example embodiments will now be described more fully with reference tothe accompanying drawings.

The present teachings generally provide patient-specific guides for usein orthopedic surgery, such as, for example, in joint replacement orrevision surgery. The patient-specific guides and associated instrumentsmay be used either with conventional or with patient-specific implantcomponents prepared with computer-assisted imaging methods based onmedical scan of the specific patient.

As described in U.S. Pat. No. 8,092,465, issued Jan. 1, 2012, and U.S.Patent Application Publication No. 2012/0226283, filed Feb. 21, 2012,both of which are incorporated by reference herein, during apreoperative planning stage, imaging data of the relevant anatomy of apatient may be obtained at a facility, including a doctor's office. Theimaging data may include, for example, a detailed scan of a pelvis, hip,knee, ankle or other joint or relevant portion of the patient's anatomy.The imaging data may be obtained using an MRI, CT, and X-Ray, ultrasoundor any other imaging systems. The imaging data obtained may be used toconstruct a multi-dimensional (such as three-dimensional) computer imageof the joint or other portion of the anatomy of the patient and preparean initial preoperative plan that may include bone or joint preparation,such as planning for resections, milling, reaming, broaching, as well asimplant selection and fitting, design of patient-specific guides,templates, tools and alignment protocols for the surgical procedure.Additionally, physical modes of the patient's joint and associated bonesmay be prepared for visualization and trialing of the guides andimplants prior to the surgical procedure.

Computer modeling for obtaining three-dimensional computer images of therelevant patient's anatomy may be provided by various computer aideddrafting (CAD) programs, applications and/or software commerciallyavailable from various vendors or developers, such as, for example, fromObject Research Systems or ORS, Montreal, Canada. The computer modelingprogram or other application may be configured and used to plan apreoperative surgical plan, including planning various bone preparationprocedures, to select or design/modify implants and designpatient-specific guides and tools. The patient-specific guides and toolsmay include patient-specific prosthesis components, and patient-specifictools, including reaming, broaching, milling, drilling or cutting tools,alignment guides, templates and other patient-specific instruments.

The preoperative plan may be stored in any computer storage medium, in acomputer file form or any other computer or digital representation,including three-dimensional graphical files or digital data sets. Thepreoperative plan, in a digital form associated with interactivesoftware or other application, may be made available via a hard medium,a web-based or mobile or cloud service, or a portable device that mayhave access to a cellular network. The plan may be provided via thevarious systems or media to the surgeon or other medical practitioner,for review. Using the interactive software or application, the surgeonmay review the plan, and manipulate the position of images of variousimplant components relative to an image of the anatomy. The surgeon maymodify the plan and send it to the manufacturer with recommendations orchanges. The interactive review process may be repeated until a final,approved plan, is sent to a manufacturing facility for preparing actualphysical components. In various embodiments, physical and digitalpatient-specific bone models, guides, and instruments may be providedpreoperatively to the surgeon for trialing and marking.

After the surgical plan is approved by the surgeon, patient-specificimplants and associated tools, including, for example, alignment guides,cutting/milling/reaming/broaching or other tools for the surgicalpreparation of the joint or other anatomy portion of the specificpatient may be designed using a CAD program or other three-dimensionalmodeling software, such as the software provided by Object ResearchSystems or ORS, Montreal, Canada, for example, according to thepreoperative surgical plan. Patient-specific guides and otherinstruments may be manufactured by various stereolithography methods,selective laser sintering, fused deposition modeling, or other rapidprototyping methods, and/or computer controlled machining. In someembodiments, computer instructions of tool paths for machining thepatient-specific guides and/or implants may be generated and stored in atool path data file. The tool path data may be provided as input to aCNC mill or other automated machining system, and the tools and implantsmay be machined from polymer, ceramic, metal or other suitable materialdepending on the use, and sterilized. The sterilized tools and implantsmay be shipped to the surgeon or medical facility for use during thesurgical procedure.

Patient-specific implants, guides, templates, tools or portions thereofare defined herein as those constructed by a preoperative plan for aspecific patient from three-dimensional images of the specific patient'sanatomy reconstructed from preoperative image scans of the patient. Thepatient-specific components are constructed to closely conform and mateor match substantially to a surface of the patient's anatomy. The matingor matching is generally as a negative mold, negative surface, orinverse or mirror surface of corresponding surface portions of thepatient's anatomy. The anatomical surfaces may include bone surfaceswith or without associated soft tissue, such as articular cartilage,depending on the particular procedure, implant and tool use. Minuteirregularities, such as those that would not affect placement of theguide, of the patient's joint surfaces need not be mirrored.

As discussed above, patient-specific alignment guides and implants aregenerally configured to match the anatomy of a specific patient and fitregister to the patient in only one position on a corresponding surfaceof the specific patient because anatomic features that are unique toeach patient may function as landmarks and may guide placement of thealignment guide or implant in only one position without the need ofintraoperative image navigation, patient marking, or otherintraoperative guidance. The patient-specific alignment guides aregenerally configured and manufactured using computer modeling based onthe 3-D anatomic image of the patient and have an engagement surfacethat is made to conformingly contact and match, as discussed above, to acorresponding surface of a three-dimensional image/model of thepatient's bone surface (with or without cartilage or other soft tissue),by the computer methods discussed above.

Generally, the patient specific guide has an exterior surface thatcontacts about 80% of the patient's anatomy when properly positioned,including about 90%, and about 98%. The exterior surface of the patientmatched guide may, therefore, substantially mate with the selectedportion of the anatomy. It is understood, however, that certain exteriorportions of a patient specific guide may not have substantial contactwith the patient, while other portions are designed to ensure contacteven when other portions are not contacting the patient. Thus, a patientmatched guide may have portions that are substantially patient matchedand have or may achieve the selected amount of contact with the patient.

The patient-specific guides may include one or more custom-made guidingformations, such as, for example, guiding bores or cannulated guidingposts or cannulated guiding extensions or receptacles that may be usedfor supporting or guiding other instruments, such as drill guides,reamers, cutters, cutting guides and cutting blocks or for insertingpins or other fasteners according to a surgeon-approved pre-operativeplan. The patient-specific guides may be used in minimally invasivesurgery, and also in surgery with multiple minimally-invasive incisions.Various guides and pre-operative planning procedures are disclosed inU.S. Pat. No. 8,092,465, issued Jan. 10, 2012; U.S. Pat. No. 8,070,752,issued Dec. 6, 2011; U.S. Pat. No. 8,133,234, issued Mar. 13, 2012; U.S.Publication No. 2009/0024131, published Jan. 22, 2009; U.S. PublicationNo. 2008/0114370 dated May 15, 2008, now U.S. Pat. No. 8,298,237, issuedOct. 30, 2012; U.S. Publication No. 2011/0224674, published Nov. 15,2011; U.S. Publication No. 2011/0184419, published Jul. 28, 2011; andU.S. Publication No. 2012/0226283, published Sep. 6, 2012, all patentsand applications are incorporated herein by reference.

With initial reference to FIG. 1, a bone preparation guide according tothe present teachings is generally illustrated at reference numeral 10.The bone preparation guide 10 includes a guide body 12. The guide body12 includes an outer surface 14 and a bone facing surface 16, which isopposite to the outer surface 14. A first side 18 of the guide body 12is opposite to a second side 20. Extending between the first side 18 andthe second side 20 is a third side 22 and a fourth side 24, which isopposite to the third side 22. The first and second sides 18 and 20 areshorter than the third and fourth sides 22 and 24, and thus the guidebody 12 is generally illustrated as a rectangular box. However, theguide body 12 can have any suitable shape, size, or dimensions.

The guide body 12 defines a compartment 26, which is proximate to theouter surface 14, and closer to the outer surface 14 than to the bonefacing surface 16. The guide body 12 defines a compartment aperture 28,which provides access to the compartment 26. The compartment aperture 28is illustrated as being at, and defined by, the third side 22. However,the compartment aperture 28 can be at any suitable location about theguide body 12 in order to provide access to the compartment 26 andpermit patient-specific insert or module 50 to be seated therein. Forexample, the compartment aperture 28 can be at the outer surface 14 sothat the patient-specific insert 50 can be dropped into the compartment26. The compartment 26 can have any suitable dimensions and be of anysuitable size and shape to receive the patient-specific insert 50therein. The patient-specific insert 50 is illustrated in FIG. 2 andwill described further herein.

The guide body 12 further defines a plurality of pin apertures 30. Thepin apertures 30 extend between the compartment 26 and the bone facingsurface 16. Any suitable member of pin apertures 30 can be included,such as six as illustrated. The pin apertures 30 can be of any suitablesize and shape to receive pins or locators 32 therein.

Each pin or locator 32 includes a distal tip 34, which may be pointed asillustrated. Opposite to the distal tip 34, each pin 32 includes aproximal end 36. Each of the pins 32 are slidably mounted within the pinapertures 30. The pins 32 are translationally mounted within the pins 32such that they can slide into and out of the guide body 12. In anextended position, the pins 32 extend further from the guide body 12than in a retracted position. In the retracted position, the pins 32 canslightly protrude beyond the bone facing surface 16 or be completelyseated within the guide body 12, such that the distal tips 34 do notprotrude out of the guide body 12 beyond the bone facing surface 16. Thepins 32 can be moved to any intermediate position between the retractedand extended positions.

When retracted, the proximal ends 36 of the pins 32 will be seatedwithin the compartment 26 to permit interaction with thepatient-specific insert or module 50, when the insert 50 is seated inthe compartment 26, as further described herein. When extended, theproximal ends 36 can still be arranged within the compartment 26, or atany position between the compartment 26 and the bone facing surface 16.Each one of the pins 32 is individually movable. The pins 32 can bemounted within the pin apertures 30 in any suitable manner, in order tomaintain the pins 32 coupled to the guide body 12. The pins 32 can bemounted such that they are freely movable within the pin apertures 30,or biased in the extended or retracted positions. The pins 32 can bebiased with any suitable biasing member, such as a spring.

The guide body 12 further defines a cutting slot 38 a, which extendsbetween the outer surface 14 and the bone facing surface 16. The cuttingslot 38 a can be of any suitable size or shape to receive a suitablecutting instrument, such as the cutting instrument 70 as describedfurther herein. As illustrated, the cutting slot 38 a has a lengthextending between the third and fourth sides 22 and 24 of the guide body12, which is greater than a width of the cutting slot 38 a extendingbetween the first and second sides 18 and 20. The cutting slot 38 a isillustrated as being arranged proximate to the second side 20, but canbe at any suitable location on the guide body 12. Any one or more of thefirst side 18, the second side 20, the third side 22, or the fourth side22 of the guide body 12 can be used as a cutting guide, such as bypositioning a suitable cutting instrument along an edge thereof.

The guide body 12 further defines a first guide bore 40 a and a secondguide bore 42. Each of the first and second guide bores 40 a and 42extend between the outer surface 14 and the bone facing surface 16. Thefirst and second guide bores 40 a and 42 can have any suitable size andshape, and can extend through the guide body 12 at any suitable angle todirect guide rods or pins inserted therethrough to a desired position ona bone. For example, the first and second guide bores 40 a and 42 canhave a circular cross-sectional shape, as illustrated. The first andsecond guide bores 40 a and 42 can be located at any suitable positionabout the guide body 12. For example, the first guide bore 40 a can bebetween the cutting slot 38 a and the compartment 26. The second guidebore 42 can be between the compartment 26 and the first side 18.

The bone preparation guide 10 is not patient-specific, but ratherpatient-generic, and thus can be reused during numerous surgicalprocedures with different patients. The bone preparation guide 10 can besterilized to allow it to be used with different patients.

With additional reference to FIG. 2, the patient-specific insert 50 willnow be described. The insert 50 generally includes a patient-specificinsert or module surface 52. The patient-specific surface 52 includes aconcave portion 54 a as illustrated, but may include convex portions aswell. Opposite to the patient-specific surface 52, is a top surface 56.The insert 50 further includes a first side surface 58 a, a second sidesurface 58 b, a third side surface 58 c, and a fourth side surface 58 d.The patient-specific insert 50 can have any suitable size and shape topermit placement of the insert 50 within the compartment 26 defined bythe guide body 12. The patient-specific insert 50 can be manufacturedusing any suitable technique, method, process, or device. For example,the patient-specific insert 50 can be manufactured using any suitablethree-dimensional fabrication process, such as selective lasersintering. Furthermore, the patient-specific surface 52 can be formed ina blank insert 50 in any suitable manner, such as by milling with acomputer numeric control (CNC) machine.

The patient-specific surface 52 is patient-specific and thus formedbased on image data of a particular patient's bone, such as a femur 60(see FIGS. 4 and 5) or a tibia. The image data can be any suitable imagedata such as that derived from magnetic resonance imaging (MRI), acomputed tomography (CT) scan, x-ray, or ultrasound data. From the imagedata, a model of the patient's bone, such as a multidimensional model,can be created. The multidimensional bone model can be, for example, athree-dimensional model. From the multidimensional model, apre-operative plan including a series of points, axes, and planesdefined by specific geometry of the patient's bone can be created andmodified by, for example, a surgeon. The pre-operative plan can identifyspecific points on a bone where the bone preparation guide 10 should bepositioned in order to prepare the bone for surgery, such as to receivean implant.

The patient-specific surface 52 of the insert 50 is designed and shapedso that when the pins 32 are placed against the specific patient's bone,the proximal ends 36 of the pins 32 contact the patient-specific surface52 and, due to the concave portion 54 a and other surface features ofthe patient-specific surface 52, extend a distance beyond the bonefacing surface 16 to precisely mate with the patient's bone. Thepatient-specific surface 52 is thus generally a three-dimensional matingimage, or mirror image, of the patient's bone. For example, in the areaof the concave portion 54 a, the concave portion 54 a will allow pins 32opposite thereto to extend further into the compartment 26, and thus notextend from the bone facing surface 16 as far as pins 32 that abut thepatient-specific surface 52 at areas other than the concave portion 54a, such as at portion 54 b. The patient-specific surface 52 is thusgenerally an inverse or negative of a specific patient's bone at an areawhere the pre-operative plan calls for the bone preparation guide 10 tobe placed, such that the patient-specific surface 52 can directly nestat only a single position on the patient's bone pursuant to thepre-operative plan.

With additional reference to FIG. 3, the cutting slot 38 a and the firstguide bore 40 a can be arranged on the guide body 12 such that theyextend through the compartment 26. Therefore, to accommodate a suitablecutting instrument and guide rod, such as the cutting instrument 70 andthe first guide rod 72 (see FIG. 5), the patient-specific insert 50 candefine an insert cutting slot 38 b and an insert guide bore 40 b. Theinsert cutting slot 38 b aligns with the guide body cutting slot 38 a,and the insert first guide bore 40 b aligns with the first guide bore 40a of the guide body 12 when the insert 50 is placed within thecompartment 26.

Although the bone preparation guide 10 is generally illustrated ashaving an overall box-like shape, the bone preparation guide 10 and theguide body 12 can have any suitable size and shape to accommodate a bonesurface to be prepared. For example, the guide body 12 can have a curvedshape, as can the compartment 26. The patient-specific insert 50 can besized and shaped to accommodate any size and shape of the compartment26. Still further, multiple compartments 26 can be included, and thusthe bone preparation guide 10 can receive multiple patient-specificinserts 50 to define one or more patient-specific bone engaging surfacesat the distal tips 34 of the pins 32.

With additional reference to FIGS. 4 and 5, placement of the bonepreparation guide 10 against a specific patient's bone, such as thefemur 60, will now be described. The bone preparation guide 10 can beplaced against an anterior surface 62 of the femur 60, which is oppositeto posterior surface 64, in order to prepare the anterior surface 62 anda distal end 66 of the femur 60, for example. The bone preparation guide10 can also be used to prepare any other suitable bone surface, such asa tibia bone surface or the acetabular cup.

After the patient-specific insert 50 is placed within the compartment26, the bone preparation guide 10 is arranged such that the bone facingsurface 16 is proximate to the anterior surface 62. As illustrated inFIG. 4, as the bone facing surface 16 is moved towards the anteriorsurface 62, the pins 32 will each be at an extended position and extendbeyond the bone facing surface 16 to generally a common distancerelative to each other. As the pins 32 are placed in contact with theanterior surface 62 and the bone facing surface 16 is moved toward theanterior surface 62, the pins 32 will be pushed into the pin apertures30 and the proximal ends 36 will be pushed further into the compartment26 until the proximal ends 36 contact the patient-specific surface 52.

Due to the patient-specific shape of the patient-specific surface 52,difference pins 32 will be able to extend further into the compartment26 than others. For example and with reference to FIG. 5, because pin 32a is opposite to the deepest area of the concave portion 54 a, the pin32 a will extend further into the compartment 26, and thus not as farfrom the bone facing surface 16 as pin 32 b, which is opposite to themore shallow portion 54 b of the patient-specific surface 52. Pin 32 ccontacts the patient-specific surface 52 at a depth intermediate to theconcave portion 54 a and the portion 54 b, and thus the pin 32 c extendsbeyond the bone facing surface 16 to a distance that is greater than thedistance that the pin 32 a extends, but less than the distance that thepin 32 b extends.

When the pins 32 contact the patient-specific surface 52, the distaltips 34 thereof generally define a patient-specific bone engagingsurface, which corresponds to an area of the femur where thepre-operative plan calls for the bone preparation guide 10 to bearranged. The pins 32 thus create a three-dimensional surface thatmatches the patient's bone. The bone preparation guide 10 can be deemedto be positioned in accordance with the pre-operative plan when thedistal tip 34 of each pin 32 is in contact with the femur 60. If one ormore of the distal tips 34 is not in mating contact with the femur 60,the bone preparation guide 10 will likely not be seated stable againstthe femur 60, thus providing feedback to the surgeon that the bonepreparation guide 10 needs to be repositioned. When the bone preparationguide 10 is positioned such that it is stable against the femur 60 andthe distal tips 34 of each pin 32 are in contact with the femur 60, thebone preparation guide 10 should be ready to be used to prepare thefemur 60, such as to receive an implant.

Alternatively, if the pins 32 are biased inward into the guide body 12,then upon placement of the patient-specific insert 50 into thecompartment 26 (typically through an opening at the outer surface 14 tofacilitate insertion of the insert 50 as well as cooperation between thepatient-specific surface 52 and the pins 32) the pins 32 will form athree-dimensional surface that matches the bone prior to the pins 32contacting the bone. The three-dimensional surface is shaped to onlymate with the patient's bone at a single location pursuant to thepre-operative plan.

The bone preparation guide 10 can be used, for example, to direct thecutting instrument 70 to the distal end 66 of the femur 60.Specifically, the cutting instrument 70 can be inserted through thecutting slot 38 a as illustrated in FIG. 5, which will be aligned at thedistal end 66 at the appropriate portion of the distal end 66 to be cutaccording to the pre-operative plan.

The bone preparation guide 10 can also be used to direct guides or pinsto the femur 60, such as first guide 72 and second guide 74. The firstguide 72 can be inserted through the first guide bore 40 a, and thesecond guide 74 can be inserted through the second guide bore 42. Thefirst and second guide bores 40 a and 42 are arranged and angled withrespect to the femur 60 according to the pre-operative plan to directthe first and second guides 72 and 74, which can be guide rods, into thefemur 60 in order to support the guide body 12 or an appropriatesecondary device to be used for further preparation for the femur 60.For example, after the first and second guides 72 and 74 are insertedinto the femur 60, the bone preparation guide 10 can be removed fromcooperation with the femur 60, and a suitable non-patient specific, orpatient generic, cutting block can be coupled to the first and secondguides 72 and 74 for making additional bone cuts, such as disclosed inU.S. Pat. No. 8,092,465 assigned to Biomet Manufacturing Corp issuedJan. 10, 2012 titled Patient Specific Knee Alignment Guide andAssociated Method, which along with all related child applications andpatents issued therefrom are incorporated herein by reference.Furthermore, the first and second guide bores 40 a and 40 b can direct adrill to the bone to drill holes therein, which can receive supportposts of any suitable guide, such as a bone cutting guide. The boneholes can also receive any other suitable support member or guide, suchas Kirschner wires (K-wires).

Subsequent to preparation of the femur 60 of a first patient, the bonepreparation guide 10 can be removed from cooperation with the firstpatient's femur 60 and the patient-specific insert 50 can be removedfrom cooperation with the bone preparation guide 10. A pre-operativeplan for a second patient can be developed, and a secondpatient-specific insert for a second specific patient can be formed. Thebone preparation guide 10 can be sterilized and re-used in anotherprocedure for a different patient.

The second patient-specific insert can be similar to thepatient-specific insert 50, which can thus be a first patient-specificinsert. The patient-specific surface 52 will be different, however, inorder to correspond to specific bone geometry of the second patient. Thesecond patient-specific insert can then be inserted into the compartment26 of the guide body 12, and the bone preparation guide 10 can be reusedto prepare the bone of a second patient. Thus the bone preparation guide10 can be reused for multiple patients and can accept multiplepatient-specific inserts to customize the bone preparation guide 10 tofit specific bone geometry of a plurality of different patients. Thebone preparation guide 10 is thus a generic guide that can be customizedto fit the specific bone geometry of different patients whenpatient-specific inserts are seated within the compartment 26. Reuse ofthe bone preparation guide 10 can favorably reduce material costs andthe overall costs of a surgical procedure.

The foregoing description of the embodiments has been provided forpurposes of illustration and description. It is not intended to beexhaustive or to limit the disclosure. Individual elements or featuresof a particular embodiment are generally not limited to that particularembodiment, but, where applicable, are interchangeable and can be usedin a selected embodiment, even if not specifically shown or described.The same may also be varied in many ways. Such variations are not to beregarded as a departure from the disclosure, and all such modificationsare intended to be included within the scope of the disclosure.

What is claimed is:
 1. A method of customizing a bone preparation guideto correspond to a specific bone geometry of each one of a plurality ofdifferent patients, the method comprising: analyzing a first patient'sspecific bone geometry; developing a first pre-operative plan based onthe first patient's specific bone geometry, a first patient-specificsurface of a first patient-specific guide insert is designed based onthe first pre-operative plan; coupling the first patient-specific guideinsert to a guide body, the guide body including a plurality of bonelocators connected thereto that are configured to be positioned by thefirst patient-specific surface of the guide insert to define a firstpatient-specific bone engaging surface of the guide corresponding to thefirst patient's specific bone geometry; positioning the guide bodyagainst the first patient's bone at a predetermined locationcorresponding to the first patient-specific bone engaging surfacedefined by the plurality of bone locators as positioned by the firstguide insert; and guiding at least one of a first cutting instrument ora first guide to the first patient's bone using the guide.
 2. The methodof claim 1, further comprising: analyzing a second patient's specificbone geometry; developing a second pre-operative plan based on thesecond patient's specific bone geometry, a second patient-specificsurface of a second patient-specific guide insert is designed based onthe second pre-operative plan; coupling the second patient-specificguide insert to the guide body, the guide body including a plurality ofbone locators connected thereto that are configured to be positioned bythe second patient-specific surface of the guide insert to define asecond patient-specific bone engaging surface of the guide correspondingto the second patient's specific bone geometry; positioning the guidebody against the second patient's bone at a predetermined locationcorresponding to the second patient-specific bone engaging surfacedefined by the plurality of bone locators as positioned by the secondguide insert; and guiding at least one of a second cutting instrument ora second guide to the second patient's bone using the guide.
 3. Themethod of claim 1, further comprising guiding at least one of the firstcutting instrument or the first guide through bores defined in the firstpatient-specific guide insert.
 4. The method of claim 1, furthercomprising coupling the first patient-specific guide insert to the guidebody by inserting the first patient-specific guide insert into acompartment defined by the guide body.
 5. The method of claim 1, furthercomprising coupling a second patient-specific guide insert to the guidebody after the first patient-specific guide insert has been removed, asecond patient-specific surface of the second patient-specific guideinsert is based on a second patient's specific bone geometry.
 6. Themethod of claim 1, further comprising moving the bone locators intocontact with the first patient-specific surface of the firstpatient-specific guide insert by placing the bone locators into contactwith the first patient's bone.
 7. A method of configuring apatient-specific bone preparation guide, the method comprising: graspinga patient-specific insert having a patient-specific surface that is athree-dimensional inverse of a bone surface to be cut; inserting thepatient-specific insert into a compartment of a guide body so that thepatient-specific surface is opposite a plurality of movable bonelocators extending into the guide body; positioning the moveable bonelocators in the guide body opposite the bone surface to be cut;translating a plurality of the movable bone locators through the guidebody to contact the patient-specific surface; and adjusting the moveablebone locators so that the moveable bone locators extend between anatomicfeatures of the bone surface and portions of the three-dimensionalinverse of the patient-specific surface that correspond to the anatomicfeatures.
 8. The method of claim 7, wherein inserting thepatient-specific insert into the compartment of the guide body comprisessliding the insert into a slot in the guide body.
 9. The method of claim8, wherein the plurality of bone locators extend through a bone-facingsurface of the guide body into the compartment, the bone-facing surfaceextending parallel to the slot such that the patient-specific surfacefaces the bone-facing surface.
 10. The method of claim 7, wherein eachof the movable bone locators comprises a distal tip extending out of theguide body and a proximal end disposed within the compartment, andtranslating the plurality of movable bone locators through the guidebody to contact the patient-specific surface comprises forming apatient-specific bone-engaging surface with the distal tips.
 11. Themethod of claim 10, further comprising: viewing the distal tips of themovable bone locators; evaluating if the distal tips are engaging thebone surface to be cut; and repositioning the patient-specific bonepreparation guide until all of the distal tips contact bone.
 12. Themethod of claim 7, further comprising guiding a guide rod through afirst guide bore defined in the guide body.
 13. The method of claim 12,further comprising guiding the guide rod through a second guide boredefined in the first patient-specific insert.
 14. The method of claim12, further comprising guiding a cutting instrument through a cuttingbore defined in the guide body.
 15. The method of claim 12, furthercomprising: removing the guide body from the guide rod; coupling ageneric cutting guide to the guide rod; and guiding a cutting instrumentthrough the generic cutting guide.
 16. The method of claim 7, furthercomprising overcoming spring bias to translate the plurality of themovable bone locators.
 17. The method of claim 7, further comprising:inserting a second patient-specific insert into a second compartment ofthe guide body; and translating a second plurality of movable bonelocators through the guide body to contact the second patient-specificinsert.
 18. A method of manufacturing a patient-specific bonepreparation guide, the method comprising: obtaining a three-dimensionalimage of a bone surface to be cut; fabricating an insert havingdimensions to fit within a compartment of a guide housing having aplurality of moveable bone locators; and shaping a surface of the insertto have a patient-specific surface having facets that are an inverse ofthe surface to be cut.
 19. The method of claim 18, further comprisingmachining the insert to form the facets of the patient-specific surface.20. The method of claim 18, further comprising inserting the insert intothe compartment of the guide housing.